If you missed the first part of the interview with Dr. Versluys you can find it here.  For more background on the six conformations read the article linked here.    I also encourage you to check out Dr. Versluys’ website, particularly the forums - a great place for discussing Canonical Chinese Medicine.

Dr. Versluys uses a few names that may be unfamiliar to listeners - I want to clarify these things for you.  Li Dong Yuan is the author of The Treatise on the Spleen and Stomach (Pi Wei Lun).  Zhang Zhong Jing is (hopefully obviously) the author of the Shang Han Lun
and Jin Gui Yao Lue (originally united as the Shang Han Za Bing Lun).  I think those are the only names he uses.

I’ll release the final part of the interview early next week - it’s a short piece focusing specifically on the issue of herb substitution and the possibility of growing Chinese herbs in the United States.  I hope you enjoy today’s podcast!  As always, feel free to leave any comments - discussion is a great thing!  :)

Eric

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Deepest Health Chinese Medicine Podcast : Interview with Dr. Arnaud Versluys LAc, PhD (Part 2 of 3)

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This is a pretty brief piece where he answers the question, “What is Classical Chinese Medicine?”  I think you’ll find some great information in there about the relationship of the Classical texts to the practice of medicine, the importance of careful study as well as some food for thought regarding the various schools of Chinese medicine.  I’ll release the second part of the podcast before the end of the week and release the conclusion, a little vignette about herbal access and herb substitution next week.

Look also for my regular Saturday podcast this week - ok, so it hasn’t been very regular lately, but I hope we can get past that.  ;)  Enjoy the podcast!

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Deepest Health Chinese Medicine Podcast : Interview with Dr. Arnaud Versluys LAc, PhD (Part 1 of 3)

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Along with a general increase in my confidence and ability comes a deep interest in REALLY learning the points and channels.  Before clinic, acupuncture very obviously played second fiddle in my hierarchy of my interests in Chinese medicine.  I have always recognized its power, but simply didn’t feel drawn to study or understand it that much.  Now, with my struggles in clinic, I find myself fascinated by each point and driven to learn more on multiple levels.  I am also developing my non-intellectual skills, my ability to feel Qi, to palpate channels and to connect with the patient.  I note this because most often when I relate my problems I have people telling me that I need to get out of my head and just “connect” with the energy of the patient.  While I recognize the importance of that, it certainly isn’t the whole answer.

My methods

Before I talk about how I’ve been working with the points, I’d like to make one small note.  I’ve divulged various study methods and tips before on Deepest Health.  With the exception of a few suggestions, these have all been methods I’ve used.  However, they were methods that I learned directly from others or developed after reading ideas in a book or on a blog.  This is a great way to pick up new strategies, and I certainly will continue to use it.  On the other hand, the methods I list below are different.  They emerged organically to solve particular problems.  What I mean is that in response to a particular experience, I desired some particular skill or understanding and worked out the best way to obtain it on my own.

This may seem to be a minor point, and I don’t want to hammer away at it.  However, it definitely feels different.  I feel more committed to consistently using these methods, and they seem to be more effective.  Each new thing I learn inflames my desire to learn even more.  A similar thing is happening to me regarding formulas, but the effect isn’t so dramatic since I’ve always been interested in understanding them.  I expect clinical practice will create some new developments in that arena, however.

In essence, what I’ve been doing is simply making a list of all the points I use in a given week and then reviewing them in great detail.  This is the bulk of my “method.”  It has several parts, which I will describe in detail below.  However, there are more subtle things that I’ve been doing in the treatment room.  I don’t know if I’m quite ready to describe those pieces of the puzzle.  One recent development was the return of very focused attention on sensing the layers of the body that the needle is passing through.  This is something we learned in our first needling class, as one of our points Professors places a high importance on needling and manipulation in the various layers.  I think being in clinic and having to manage so many things at once found me being a little neglectful in this realm - I’m glad I’ve remembered it now.

Anatomy : Descriptions, 2D, 3D, palpation and multiple sources

I’ve never been particularly interested in gross anatomy.  In fact, this new revolution in my thinking has helped me to understand that I have an odd detachment from the physical nature of the body in general.  Working with the anatomy has helped unravel that personal issue, yet another example of the many benefits of dedication to study.  Anyway, we did take anatomy during our first year, but given my general reluctance described already and the fact that I was so enthralled with learning the cosmology and symbolism of Chinese medicine, I frankly didn’t pay much attention.  I’ve used various sources to help deepen my understanding of anatomy.

Descriptions:  Sometimes a word is worth a thousand pictures.  While seeing what things look like on the body is very important, often it has been a stray description of a particular bony landmark in relation to a point that has really solidified its location for me.  I use Deadman
as a primary source here.

2-D:  Again, Deadman’s Manual of Acupuncture has lovely drawings - including the ones at the back of the book that show points by region of the body.  I also use some simple illustrations by Worsley’s group, my Living Meridian Location Charts and some compilations of Chinese sources put together by NCNM Professor Jim Cleaver.  Jim has also provided some schematic representations of body areas so its easy to get a feeling for the cun relationships among channels on the same part of the body.  I just leaf through these sources at random seeking to really understand where the point is, in general, located.

3-D: I have an old version of Qpuncture that has 3D renditions of a needle in various commonly used acupuncture points.  While some of the anatomical accuracy has been sacrificed, it is very helpful to see how the needle penetrates with reference to the anatomical markers we cannot see with the eye.  I also subject my partner and daughter to infrequent channel palpation and point location (”Is this sensitive?  What about this?  This?”) which is often very helpful.  Of course, while I’m studying the above sources, I palpate my own channels and feel the points on myself.

“Actions”, prescriptions and theory

The point location has been most bothersome for me, mostly because I’m obsessed with being sure that every needle has a real effect.  That may seem to be a stupid statement.  However, I’ve been needled by many interns and practitioners who don’t seem too interested in actually working with the POINTS - content just to needle anywhere on the body.  I gather this from my perception of their lack of intention when needling, the obvious lack of accuracy based on where the needles end up as well as my conversations with them.  I do believe that the “points” as they were laid out in ancient times are very special places on the human body that have powerful effects on the human being - I don’t think that “just anywhere” will do.

Despite my obsession with fully knowing where the points are, I haven’t lost sight of the importance of understanding “what they do.”  I put “what they do” and “actions” in quotations for a reason.  Acupuncture points are not like buttons on a machine.  It’s not as if you press the red one and you get a cherry candy, blue one and you get a razzleberry one.  It’s not as if some little ghost in the machine stands behind the point ready to report your instructions via the CNS with exactness and machine-like one-to-one correspondence.  If a person asks me for “a point for asthma,” I’m reluctant to report the points we all know to be commonly used in prescriptions for that Western defined condition.  It isn’t that points don’t “do something” and it isn’t that I’m afraid to talk about certain points as unequivocally treating some particular pathological state, it’s just that the way we try to simplify things for easy consumption result in overly simplistic ideas about how Chinese medicine works.

I think about acupuncture points like areas where one can access a river. They come in big and large sizes, they have varying ranges of ease of access, some put you in at a furious current, others at gentle pools.  The direction you’re heading when you put in at any given point makes a difference, as does your intention when you do so - will you paddle upstream or let the current carry you down?  Are you fighting the flow or not?  Are you dredging the channel a bit to allow greater flow in a given area?  Are you moving boulders that have obstructed your path?

The river metaphor breaks down a bit when we drill down a little more.  Each point has its particular characteristics based on its location on the channel, its symbolic power given the part of the body and its physical features as well as a whole range of correspondences that fit the channels and points and the human being in with the consistent patterning of the universe.  Thus five elements, yin-yang, six divisions and all their permutations and combinations are peppered throughout the system in remarkably predictable and usable ways.  When we needle a patient, we are not pushing buttons, but mixing colors and flavors, textures and spirits in alchemically beautiful ways with the purpose of influencing the body in particular ways for the creation of health.

You know, no big deal.  :D

All that being said, I’m not just going to abandon myself to studying nature and meditating as a way to understand what KINDS of mixtures are effective in what kinds of situations.  I’m not comfortable with that, frankly.  Instead, I look to the classics and the theories passed down by the ancients. I use Deadman and some sources given to me by my teachers to understand the Classical point prescriptions.  I study closely the theory of the five elements and six conformations as well as point categories to fully comprehend the effect of a given point within a particular clinical context.

All of this is really helping my clinical confidence a great deal and I find that more often than not I am able to recall most of this information when I next encounter a particular point.  Sweet!  I’ve talked enough about this for now, but I would like to pose a couple of questions.  Have you encountered the kinds of troubles I started out this article by describing?  If so, how did you get past it?  Do any of the methods or ideas above resonate with you?  If so, how?  If not, why not?  I’d really like to hear about others’ experiences.  Reply in the comments!

Thanks!

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Necessity is the mother of learning acupuncture points

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However, even if we prescribe and prepare the herbs exactly as indicated it means nothing if the quality of the herbs is terrible.  Recently, in a class at NCNM, a professor allowed us to taste Fuzi from different sources.  We had three samples of bulk Fuzi.  One was from a popular herb company, the second was from China, specially prepared in the traditional way at the instruction of Heiner Fruehauf.  The third was raw Fuzi - unprepared - from China.

We were asked to observe how the herb tasted, its texture, and how it made us feel.  The first batch was - depressing.  It was brittle, soft, had almost no flavor and absolutely no bodily sensation resulted from tasting it.  This is similar to what is found in many clinics.  We tasted the second batch a few minutes later, the differences were striking! There was an almost immediate pungency and quite a bit of numbness on the tongue.  This numbness continued for quite a while.  We have been told by several professors that we want to find this quality in the Fuzi we prescribe to our patients - it indicates that the living potency of the herb is retained.

The best fun happened when we tasted (just a bit) of fresh Fuzi.  Oh boy!  My THROAT was numb after that one.  You could really feel the medicinal quality - it was incredible.  The only thing I could think after this little taste test was, “How can we get more of the good stuff and less of the bad stuff?”  The consensus seems to be that the best quality Fuzi is not available in the states or really anywhere in the West.  Further, the recent earthquake in China apparently did great damage to the areas where much of the high quality Fuzi is produced - creating even greater shortages.

The quality of the initial herb is only part of the problem - processing is the next piece of the puzzle. Fresh Fuzi is often brined, and then treated in various ways.  Reports have indicated that industrial chemicals and harsh processes are used in the preparation of lots of commercial Fuzi.  At the very least, you can tell that much of what’s available from the major herb companies is wildly over-brined.  The brining process reduces the toxicity of the herb - but we have to remember that the “toxicity” of herbs (usually produced by alkaloid content) is a large part of why it is clinically effective!  Skilled herbalists know how to exploit the positive nature of the herb while minimizing the potential for harm from the strong compounds contained within.  When we overprocess herbs, we don’t do anyone any favors.

How can we, in the contemporary West, make up for these various deficiencies? How can we prescribe herbs in the way they are meant to be prescribed - full of their vital force and particular benefits?  How can we know if an herb has been processed appropriately?  These questions can easily be added to the ones I’ve had about using local species and other related conversations on Deepest Health.  I’m looking forward to hearing what you think about this important issue.  Please voice your thoughts and share your research with us in the comments!  No registration is necessary.

Eric

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Herbal quality : the Fuzi (aconite) dilemma

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The details are largely unimportant.  I do think there’s something important in all of it.  As a person who is absolutely committed to being a lifelong scholar and practitioner of Classical Chinese Medicine, as a person who has taken the better part of four years to even begin to understand what that means, as a person who has had the unique and wonderful opportunity to work with a variety of folks who have done what I want to do, I have come to seen the difficulty of this task before me.

The difficulty has something to do with the nature of the medicine itself - it is variegated, multi-layered, mysterious, divine.  It is the product of thousands of years of histories in more than one country, in more than one political climate, touched and shaped by hundreds of thousands, even millions, of practitioners.  The difficulty also has something to do with the particular place and time where I find myself.  The way I was raised as a 20th century American kid, the rocky adjustment to the 21st century we’re all making, the political climate of the United States today along with its interpenetration by the world’s political climate, the way that Chinese medicine is practiced in the US… all of this and so much more.  The difficulty also, of course, has something to do with just me.  Just me as a human being, flawed and persistently stubborn.  I imagine I’m not the only person who has had some difficulty figuring out how to be an excellent and integral practitioner of this medicine in the 21st century West.

Over the last four or five weeks, I’ve been challenged on multiple fronts.  I’ve had my confidence rocked in clinic.  I’ve wondered about my focus.  I’ve worried about my ability to integrate all the material before me.  I’ve struggled to make things fit, time-wise.  I’ve panicked about boards, about business planning and about various administrative problems.  I’ve felt thoroughly dispersed.

Then came the steely cold rains of another Pacific Northwest autumn.  And with all the agitated heat of late summer, washed away were the bulk of my worries and strivings.  Through the clear Fall air I could see my problems perfectly, I could see solutions in the distance against the backdrop of Mount Hood.  With each purifying breath, I felt my energy renewed.  The gifts of the metal energy of Autumn.  I ready myself for intensive consolidation, for the pulling inward of the winter - for warm fires safe under the roof being pounded by rain, for squash soup and roasted potatoes, for Moxa on Zu San Li (Stomach-36) every morning with my tea.  Most of all, I welcome the descent into the certainty of my future, for the birth of my scholarhood, for the resting in the calmness of the deep watery ocean of my destiny.

Every year, the five elements and their associations become even more potent as my teachers.  I hope to share some of this with my patient readers.  As things consolidate enough to be grasped, I will be happy to show you what I’ve found.  :)

Eric

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Consolidation and the descent into winter

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Deepest Health reader Jason suggested that I write an article about this topic, which spurred me to action.  He writes:

“With the economy in a very precarious situation, what does that mean for practitioners of Chinese medicine, or indeed any CAM therapist? What would be some good strategies for weathering an economic downturn (or heaven forbid, an economic meltdown)? And for people like me, is this even a good time to invest the time and money for an education is Chinese medicine? In my perfect world, I’d do it anyway, and then I would treat anyone regardless of what they can pay. Just can’t ignore the money though, can you?”

Indeed.

There are a number of issues embedded in Jason’s statement. Before I offer my observations, I’d love to pose the two main questions to Deepest Health readers - post your responses in the comments.  I look forward to a lively discussion!

1.  From a practitioner perspective, what are some good business strategies for weathering an economic downturn?

2.  From a student perspective, is this a good time to pursue education in Chinese medicine?

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Chinese medicine and the troubled economy

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It’s been a funny beginning of the Autumn season and I’m doing my best to adapt to the shifting energy.  Good things are coming to Deepest Health soon, particularly if you’re a student or relatively new to Chinese medicine (you know, like me) but for now I just have a quick suggestion.

Learn more about the energy of your days as described via Chinese astrology!  Fortunately, I have a simple and beautiful way for you to do that.  My friend and colleague, Brandon Brown, has just created a quite lovely and accurate calendar that contains all the pertinent Chinese astrological data.  By using his calendar you not only help support a fine budding scholar of Chinese medicine, but you also get to learn more about this fascinating system for looking at the world.

After you buy and have used it for a while, come back and let us know how it’s going.  I find that paying close attention to these things tends to shift my consciousness quite a bit.

Eric

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Chinese astrological calendars - get yours today!

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Anyway, in a fantastic lecture by Dr. Arnaud Versluys this weekend, I was reinspired to consider a very real problem in Chinese herbal medicine.  We use herbs that travel long distances, are sometimes beset with chemical and heavy metal toxicity, are sometimes banned by ill-informed government agencies and some of which are becoming rare and, thus, expensive.  Given that I am very serious about a rigorously authentic Shang Han Lun and Jin Gui focused herbal practice, I am not one to willy-nilly make substitutions that just “seem to work.”  Yin Qiao San SEEMS TO WORK (sometimes).  That doesn’t mean I’m going to use it, you know? The problem is the untested nature of these substitutions which may, in fact, damage Yang and so cause problems for the patient down the road. So, it’s something that I want to think through carefully.

The particular herb that came up in discussion about this issue was Xi Xin - Asarum - Wild Ginger. I love this herb.  It’s used in a couple of indispensible formulas, perhaps most importantly in Dang Gui Si Ni Tang.  Most herbalists agree that there’s simply no substitute for Xi Xin, but I’ve seen or heard of people try to replace it with Wu Tou, Yu Jin, Sheng Jiang + Mai Men Dong (?!) and other interesting combinations.  Most of these same herbalists agree that it’s simply not the same without Xi Xin.

The ban on Xi Xin for practitioners is ridiculous to the extreme and I’m not going to discuss that here.  What I would like to hear people discuss is how they make substitutions in these cases.  When an herb you need isn’t around, what do you do?  What herbs have you had to learn to live without?  I understand that UK herbalists are quite restricted in what they can prescribe - how have my UK readers dealt with this problem?  Even when a governmental agency isn’t busy interfering, we sometimes lose herbs.  Consider Xi Jiao, rhino horn.  Consider the precarious state of Ren Shen, ginseng.

There are a couple of associated questions that come up when one considers this issue.  One is - should we simply learn to work with fewer, simpler herbs?  Dr. Versluys is known to say that he thinks he could do a fair job of treating patients with only 10 herbs - a set of cooling herbs in each of five flavors and a corresponding set of warming herbs.  If you know formula science and architecture, such artistry is certainly possible.  Is this the standard towards which we should strive?  It seems far superior to the never ending quest for the “perfect herb for cancer” or memorizing five hundred herbs, over half of which are specialized for particular symptoms.

Taking this a little bit farther, we should consider the wisdom of relying on herb sources that can only be accessed by air shipments from another continent.  Given peak oil, given the unstable political nature of our planet, given the environmental crisis we find ourselves in… should we at least consider the possibility that we may need to rely on local sources for our herbs at some point in the future?

My friend said an interesting thing to me today.  In the course of discussing this various issue he said, “To be true Classical Chinese herbalists, we should use the herbs we find around us.” I didn’t question him any farther on this issue, but I think he’s right from some perspectives.  Learning the Chinese herbs and formula science so deeply that it is second nature allows us to look at all plants, animals and minerals with the eyes of a Classical Chinese herbalist.  Then it seems at least possible that we could, if necessary, find other materials that meet the needs of our patients.

I’d be interested to hear your thoughts on this rambling post.  Doubtless there are many opinions out there - share them here on Deepest Health by responding in the comments.  No registration is necessary and you can even post anonymously if you are respectful.

Thanks for reading,

Eric

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Chinese herb substitution and using local species

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